Hindawi Publishing Corporation

BioMed Research International

Volume 2015, Article ID 531789, 6 pages
http://dx.doi.org/10.1155/2015/531789

Clinical Study
Qigong as a Traditional Vegetative Biofeedback Therapy:
Long-Term Conditioning of Physiological Mind-Body Effects

Luís Carlos Matos,1 Cláudia Maria Sousa,1 Mário Gonçalves,1,2,3 Joaquim Gabriel,4
Jorge Machado,1,5 and Henry Johannes Greten1,2,3
1
Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Largo Professor Abel Salazar 2,
4099-030 Porto, Portugal
2
German Society of Traditional Chinese Medicine, Karlsruher Straße 12, 69126 Heidelberg, Germany
3
Heidelberg School of Chinese Medicine, Karlsruher Straße 12, 69126 Heidelberg, Germany
4
Departamento de Engenharia Mecânica, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, s/n,
4200-465 Porto, Portugal
5
Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200 450 Porto, Portugal

Correspondence should be addressed to Henry Johannes Greten; heidelbergschool@aol.com

Received 29 August 2014; Revised 19 December 2014; Accepted 17 January 2015

Academic Editor: Shirley Telles

Copyright © 2015 Luı́s Carlos Matos et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

A contemporary understanding of Chinese Medicine (CM) regards CM diagnosis as a functional vegetative state that may be
treated by vegetative reflex therapies such as acupuncture. Within this context, traditional mind-body exercises such as Qigong
can be understood as an attempt to enhance physiological proprioception, by combining a special state of “awareness” with
posture, movement, and breath control. We have formerly trained young auditing flutists in “White Ball” Qigong to minimize
anxiety-induced cold hands and lower anxiety-induced heart rate. Functional changes occurred 2–5 min after training and were
observed over the whole training program, allowing the children to control their symptoms. In our current work, we report that
warm fingers and calm hearts could be induced by the children even without Qigong exercises. Thus, these positive changes once
induced and “conditioned” vegetatively were stable after weeks of training. This may show the mechanism by which Qigong acts
as a therapeutic measure in disease: positive vegetative pathways may be activated instead of dysfunctional functional patterns.
The positive vegetative patterns then may be available in critical stressful situations. Qigong exercise programs may therefore be
understood as an ancient vegetative biofeedback exercise inducing positive vegetative functions which are added to the individual
reactive repertoire.

1. Introduction Several studies on Qigong-related effects concerning

The contemporary understanding of the diagnosis in Tradi-
tional Chinese Medicine (TCM) considers TCM as a tradi-
tional model of vegetative system biology with the purpose
of a systemic therapeutic approach [1–8]. Within this concept,
Qigong is understood as a traditional vegetative biofeedback
therapy consisting of concentrative motion and postures
combined with breathing exercises. Actually the “qi activa-
tion” is achieved by breath control and a special mental state
of “awareness” [9, 10], thereby improving and strengthening
the overall state of vegetative regulation (homeostasis) [1, 11–
15].
physiological processes and variables have been published
elsewhere. Actually some of these studies point to significant
changes on parameters such as the blood pressure, heart rate
and variability, decrease of plasma triglycerides, total choles-
terol and low density lipoprotein (LDL) cholesterol, increase
of HDL cholesterol, skin temperature, and improvement in
lung functions such as the increment in forced expiratory
volume and the reduction in the number of exacerbations,
between others [16–22].
One of the prime benefits of Qigong seems to be stress
reduction, and one of the main concepts of this practice is to
use the mind to guide activation and deactivation patterns by
2 BioMed Research International
imagination. Excessive stress may have a negative impact on
the health state of a person and may be associated with an
increase of anxiety, psychological disorders, and functional
impairments of organs within the body [11]. It was shown
that Qigong training may reduce emotional exhaustion and
depersonalisation and even improves anxiety and reinforce
attention and effectiveness in high school students [23–34].
Although in some European countries Qigong is consid-
ered and supported by the health systems as a preventive
measure, training programs for children are not widely
spread. As this is possibly due to a lack of data, we were
interested in a further understanding of the modes of action
of Qigong. We chose the so-called “White Ball” exercise
system, as it takes 5 min to do it and can be integrated at work
or at school [9, 10].
In its traditional understanding, TCM holds that “qi,”
a functional power in the body, may be seen in functional
physical signs. These are related to measurable physiological
processes and aspects such as the increase of the peripheral
microcirculation, thus the increase of the skin temperature
and the changes on acupoints electrical potential and resis-
tance and even on the surrounding biomagnetic field [24, 35–
37]. Objective detection methods to evaluate the physical
effects of Qigong therefore are an important prerequisite for
the development of clinical study designs. Some authors have
reported significant changes in the intensity and frequency
of the infrared radiation emitted from the hands of Qigong
practitioners, as well as detection of dynamic changes of
temperature by thermography [24, 38, 39]. Qin et al. (1997)
suggested that infrared thermography could be used to
measure the dynamic changes of temperature in the hands
and arms during Qigong practice [39].
We had previously refined this method and shown that
young flutists, suffering from cold hands and elevated heart
rate before auditions, would show elevation of hands tem-
perature and reduction of anxiety-induced heart rate after
the Qigong exercises and along the training program. We
were now interested whether this effect was only to be seen
while training was going on or whether Qigong exercises
can result in stable changes of the functional vegetative
repertoire, which we could even call a remodelling of vege-
tative functions and pathways. In this sense, stable changes
of vegetative functional reactions would explain long-term
effects of Qigong by the remodelling of vegetative functional
patterns. It would also explain some of the positive long-term
emotional changes, as emotionality and body experience are
understood as interrelated [5, 40].
2. Materials and Methods
2.1. Sampling and Study Design. A group of seven healthy
Caucasian volunteer children, aged between 10 and 12 years,
six females and one male, students of flute from a local
music academy, and without any previous experience in
Qigong, were examined for Qigong-related effects against
performance-related anxiety in well-controlled conditions
[25]. In addition to the physiological measurements of that
study, we could examine the effects of the exercises by
thermography of the hands prior to and after a seven-
week Qigong training program. Control experiments were
conducted with the same individuals, so each one performed
two consecutive measurements, the baseline or control and
the Qigong exercise. In these two assays, the adopted physical
posture was the same; however, the intention, mind focus, or
the achievement of a “special mental state of awareness” was
completely different.
2.2. Infrared Thermography. Experiments were performed at
a mean room temperature of 20∘ C measured with a type K
thermocouple connected to a Labfacility digital thermometer,
model 2000L. An Infrared camera from FLIR, model A325
(sensibility < 0.07∘ C; precision ±2%), was used and supported
by a tripod, placed 2 metres away from the target. Capture
and image analysis were carried out with the program
ThermaCAM Researcher Pro 2.9 from FLIR Systems, and the
recording frequency was one photo every ten seconds.
2.3. Qigong Posture and Training. The Qigong exercise
selected for this study was the “White Ball” standing exercise
according to the Heidelberg Model of TCM as described
in detail elsewhere [10]. In brief, the exercise chosen from
this system includes a nondynamic basic Qigong posture,
similar to the Wu Chi posture in the Zhan Zhuang system
[41–43], minimizing the effects of physical movement. In
the exercise, the imagination of holding the ball in front of
the abdomen (so-called lower Dantian) is used to induce a
sensation traditionally referred to as “qi” sensation, similar
to “deqi” sensation observed in acupuncture. Children were
instructed to do the exercise daily for seven weeks. They had
accompanied training for 30 minutes with an experienced
Qigong practitioner twice a week.
2.4. Statistical Analysis. The following variables were con-
sidered in the thermography analysis: final temperature on
the tip of the middle finger (FT TMF); activation time (AT:
time to increase 1∘ C on the tip of the middle finger); final
temperature on Láogōng, Pc8 (FT Pc8); heating rate (HeatR—
∘
Cs−1 ).
Pearson correlation analysis and principal components
analysis (PCA) were performed to detect structure in the
relationships between variables. Eigenvalues were observed
and two factors were enough to explain almost all the
variabilities. Results are shown as figures and tables. Pearson
correlation analysis and PCA were performed with Statistica
for Windows release 6.0.
3. Results and Discussion
In brief, thermography indicated changes of local microcir-
culation during the exercises as shown in Figure 1.
Statistically significant changes in temperature measured
by thermography occurred during the exercises and at the
beginning and at the endpoint of the observation interval.
Highly significant differences (𝑃 < 0.01) were obtained
when comparing the first and second assays with the respec-
tive baselines. Moreover, when comparing the first with
BioMed Research International 3

(a)

(b)

Figure 1: Thermograms of the Qigong exercise ((a) before; (b) after).

2.0 2.0

1.5 1.5

1.0 1.0
B1 B5
B3
Factor 2: 13.43%

A7
Factor 2: 4.88%

0.5 0.5 A4
B4 A1
A5
0.0 0.0
B6 A3 A2
−0.5 B7 −0.5 A6
−1.0 B2 −1.0

−1.5 −1.5

−2.0 −2.0
−4 −3 −2 −1 0 1 2 3 4 5 −4 −3 −2 −1 0 1 2 3 4 5
Factor 1: 83.87% Factor 1: 91.60%

Figure 2: Principal components analysis (PCA) concerning the Figure 3: Principal components analysis (PCA) concerning the
variables FT TMF, AT, FT Pc8, and HeatR at the beginning of the variables FT TMF, AT, FT Pc8, and HeatR at end of the Qigong
Qigong program. program.

the second assays no statistically significant differences were
obtained (𝑃 = 0.364). This could be an indicator that this
group of children quickly developed the capacity of vegetative
activation through Qigong practice being able to minimize
anxiety-induced cold hands in a short period of time and
on demand as a part of the child reactive repertoire. Fur-
thermore, there was an improvement on the performance
of almost every child along the Qigong program, with a
tendency to a homogeneous response on the measured
vegetative effects, as can be seen when comparing the PCA
results shown in Figures 2 and 3. On the mentioned figures,
dots are plotted according to the PCA scores related to the
variables (Figure 4) and represent each child, before (b) and
after (a) the Qigong program. Moreover, dots plotted on
4 BioMed Research International

1.0 1.0

T Pc8
0.5 0.5
T Pc8
Factor 2: 13.43%

Factor 2: 4.88%
FT TMF AT FT TMF AT
0.0 0.0

HeatR

HeatR
−0.5 −0.5

−1.0 −1.0
−1.0 −0.5 0.0 0.5 1.0 −1.0 −0.5 0.0 0.5 1.0
Factor 1: 83.87% Factor 1: 91.60%
(a) (b)

Figure 4: PCA variables projection on the graphical plane: (a) before and (b) after the Qigong program.

0.07 Table 1: Correlation between the heating rate (HeatR) and the heart
0.06 rate (HR) and final temperature on the tip of the middle finger (FT
Heating rate (∘ C s−1 )

0.05 TMF) at the beginning and ending of the Qigong training program.
0.04
0.03 Variable HR FT TMF
0.02 𝑟 = −0.423 𝑟 = 0.764
HeatR beginning
0.01 𝑃 = 0.345 𝑃 = 0.045
0.00 𝑟 = −0.625 𝑟 = 0.878
−0.01 A B C D E F G HeatR ending
𝑃 = 0.133 𝑃 = 0.009
Children

Baseline
First assay can be confirmed by the activation time of less than 2 minutes
Second assay in all tested individuals.
Heart rate results point to a significant decrease of this
Figure 5: Heating rate for each child (A to G) in the baseline assay
variable along the Qigong program, thus indicating a higher
and at the beginning and end of the Qigong training program.
level of relaxation and a lower level of anxiety. Actually the
mean heart rate at the beginning of the program was 102.9
beats per minute, with a standard deviation of 20.5 beats
Figure 3 are close to each other, thus indicating a group per minute and at the end these values were 92.0 and 17.2,
tendency that reflects the vegetative conditioning of positive respectively.
physiological effects within the program. As can be seen in Table 1, the heating rate correlates
As can be seen in Figure 5, with exception of child B, negatively with the heart rate, meaning that the heart rate
there was a general noticeable increase of the heating rate tends to decrease as the faster hands temperature gets higher.
at the end of the Qigong training program. This means Oppositely, the final temperature on the tip of the middle
that children developed the ability to quickly activate and finger (FT TMF) correlates positively with the heating rate,
increase the hands microcirculation, thus increasing the thus indicating that the faster the heating rate, the higher
hands temperature in a shorter period of time. the FT TMF. In both cases, the correlation coefficient 𝑟 is
The time until physiological activation was less than 2 higher for the results of the second assay, pointing to an
minutes in all examined cases. The results indicate that, improvement of the Qigong group.
like in other Qigong exercises, the system of the “White
Ball” can change the temperature of the skin as shown by 4. Conclusions
thermography. Unlike other “qi” exercise cycles in TCM, the
“White Ball” system is only a short exercise of approximately Our findings show that children quickly learned this Qigong
5 minutes. The short duration nature of this Qigong exercise system with obvious development of individual vegetative
BioMed Research International
skills and the reduction of anxiety-induced effects. These
effects were stable after weeks of training, allowing for playing
the flute with warm fingers and reduction of the anxiety-
reduced elevation of the heart rate even without prior applica-
tion of Qigong exercises. It seems that these positive vegetative
changes in the behavioural pattern appear to be naturally
available on demand in critical stressful situations as a part
of the child reactive behavioural repertoire. We consider this
to be an effect by conditioning a vegetative new pattern.
Therefore, our data suggest that, by the exercise, a change in
the functional vegetative pattern is first elicited. This may be
then engrammed and conditioned to be elicited by another
stimulus, in this case the context of flute and audition. Having
to audit then elicits a functional pattern that is free from
anxiety-induced manifestations of the vegetative system.
Overcoming the dysfunctional and disturbing effects of
individual challenges in life may be considered to be a
necessity for the prevention of a number of constellations
like blackouts in examinations, failure in professional pre-
sentations, panic attacks, and states of anxiety and burn-out.
Our data suggest that Qigong, if correctly understood and
practised, may be a useful tool in this context.
Our data may also be helpful in the demystification
of Chinese Medicine. Thermography allows visualizing the
effects of the microcirculation on the hands temperature
during Qigong practice. Actually, TCM holds that the “mind”
guides the “qi” which guides the “xue” (blood).
The Heidelberg model of TCM sees strong analogies of
the effects of “xue” as described by the classical scriptures
with the clinical effects of microcirculation in Western
medicine. Therefore, “qi,” translated by this model as a
vegetative functional capacity, guides and steers the micro-
circulation. In other words, this old phrase from classical
scriptures can be demystified as “the mind” (imagination and
awareness) can guide and therefore activate vegetative capac-
ities, which in return lead to changes in microcirculation.
We believe that such demystifying approaches to the cor-
pus medicus of Chinese Medicine may be helpful to objectify
its vegetative mechanisms underlying Qigong therapy and
acupuncture. These exercises should be further explored and
demystified as an ancient form of vegetative biofeedback
therapy with long clinical experience.
The “White Ball” system is a simple, short duration
Qigong exercise, easy to learn, that does not require much
space, with positive effects on anxiety and stress management.
It could be a powerful tool in the management of these dis-
orders even when used in a classroom, at work, or elsewhere.
As the conditioning effect may be more pronounced in the
developing nervous system, these helpful patterns may be
especially worthwhile and effective in children. Therefore,
the supposed mechanisms of conditioning positive vegetative
behavioural patterns suggest the application of these exercises
especially at a young age.
Conflict of Interests
The authors declare that there is no conflict of interests
regarding the publication of this paper.
5
Acknowledgment
The authors would like to thank Petra Fröschen, Heidelberg
School of Chinese Medicine, for writing and editing assis-
tance and for reviewing the paper.
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